Malignant tumors remain the leading cause of death in China. Their pathogenesis and progression involve multifaceted mechanisms, including genetic mutations, aberrant activation of signaling pathways, and dysregulation of the tumor microenvironment. Current clinical management continues to face significant challenges, such as chemotherapy resistance and the limited efficacy of targeted therapies. Aloe-emodin (AE), a primary anthraquinone active constituent found in the traditional medicinal plant Aloe, demonstrates a promising multi-targeted and multi-mechanistic profile as an anti-tumor agent. This review systematically elucidates the antitumor mechanisms and related research progress of AE, specifically highlighting the induction of autophagy via inhibition of the protein kinase B (Akt)/mammalian target of rapamycin (mTOR) axis, the promotion of apoptosis through activation of mitochondrial pathways, the suppression of invasion and metastasis by downregulating matrix metalloproteinases (MMPs), and the enhancement of antitumor activity via modulation of the tumor immune microenvironment. Additionally, AE enhances antitumor activity by modulating the immune microenvironment. Furthermore, the therapeutic potential of AE is validated through structural optimization and drug combination strategies. This review highlights recent advances in understanding the molecular mechanisms of AE and anticipates its clinical translation, aiming to provide a theoretical basis for cancer therapy and inform the development of novel treatment modalities.

aloe-emodin  /  antitumor activity  /  apoptosis  /  Akt/mTOR  /  structural modification  /  combination therapy